Our flights were uneventful, though quite long, and we arrived in Tanzania without a hitch. Jess and Nick flew on Qatar Airlines, a first for our group, which meant that they had arrived earlier in the day. I had arranged for them to be picked up at the airport by KIA Lodge which is a wonderful little airport hotel unlike any in the US. It is a little oasis with an outside bar for drink and food. And hey, it’s in Tanzania!

In the past we have always had our visas in advance rather than buying them at the airport for the sole purpose to avoid the crowded lines of tourists who weren’t so prepared as you can only imagine what it’s like for a jumbo jet to descend onto a very small airport with it’s 200+ passengers. Basically, it’s not fun. And now I can tell you that from personal experience. For the first time, everyone needed to purchase a business visa in addition to the regular tourist visa to enable us the privilege of volunteering here. I have a resident permit good for two years so I don’t have to go that route, but both Jackie and Jess did. The Tanzanian embassy in the US hadn’t gotten the memo yet so they had no idea what I was talking about when I phoned them several times over the last month so as to avoid the mayhem of the airport. Not surprising.

I waited in line with Jackie to make sure things wen’t smoothly and we were reassured when the woman at the visa window actually seemed to understand what we were asking for. Once Jackie had secured her visas and was now in line for immigration, I went off to find our luggage and begin the adventure of going through customs. You may recall the hassle we had on our last visit bringing in the EEG machine and so I was prepared to encounter another hurdle in the process of just trying to get to FAME to do the work we had planned. With Jackie now in the correct line to get into the country, I decided to begin the customs process. We had four 50 lbs. duffels along with our carry on baggage that all needed to go through the X-ray machine and it wasn’t long before I was being asked lots of questions. Yes, we had a number of laptops in one of the duffels. No, I don’t know what those round containers are in the foot of that duffel (turns out they were the freeze dried green beans I was bringing for the ex-pat veterinarian in Karatu). I guess it was when they opened Jackie’s duffel, which is where we had put all the medications we were bringing to FAME, that I started to worry. They hadn’t even yet asked me to open the endoscope I was bringing to FAME! So at this point they called over the representative for the health ministry and he informed me that I would need paperwork and prior approval to bring everything in. Thankfully, I had a number of documents from FAME including a letter of introduction for me and somehow this was enough for them. He wrote me a nice letter to document that it was OK for me to bring the items in and smoothed things over with the customs agent who was still lurking in the background waiting for me to give him an invoice for the laptops so he would be able to calculate whatever it was he wanted me to pay. Luckily, that never materialized and we were on way without an exchange of money.

Having finally extricated ourselves from the grip of the Tanzanian authorities – health ministry, immigration and customs – we focused on finding Jess and Nick. They had arrived hours earlier and were patiently waiting for us to retrieve them at the KIA Lodge bar – not to shabby of place to wait, but I was pretty sure they’d be anxious to see us. We found them relaxing at an outside table, Jess having just woken from a nap following her awesome massage that she had arranged at the lodge. I detected no anxiety in their demeanor. We loaded all of our luggage and were on our way to Arusha, albeit a bit later than we had hoped, but no worse for the wear considering our tribulations at the airport. A late dinner with Pendo and all was well in the world.

It seems like only yesterday that we were climbing the slopes of Kilimanjaro along with setting up the first EEG studies at FAME. But alas, it’s almost March again which means another trip to visit my second family at FAME and with the Tembas in Njiro, near Arusha. We had such an amazing trip in October, and not just because of our incredible experience on Kilimanjaro. Rather for the hard work that everyone put into the program to make it the absolute most productive both from a patient care standpoint as well as educational for the caregivers at FAME, which, after all, is the mission of FAME and the single biggest reason we keep going back again and again.

We have lots of plans for this trip that include everything from hopefully breaking group on the new “Raynes House” to further discussions with FAME concerning the continued (and growing) relationship with Penn over the coming years. My dream has been to eventually involve other specialties from Penn and to create a much bigger presence there. It was Fima’s visit last October that paved the way for that to occur and with everyone’s help we will continue in that direction. Piggybacking on the success of last fall’s trip we will continue to see many of our returning epilepsy patients as well as a whole cadre of new ones who will quickly realize that epilepsy is a very treatable neurological disorder that need not be suffered to the extent that it is.

We are back to the model of having both an adult and a child neurology resident with me which is always the best since about half the patients we see are children. Jackie, our child neurologist, has been to Africa before, but this will be her first medical visit there. This will be Jess’ first visit to Africa as well as her first global health stint. The fourth in our group is Nick, Jess’ boyfriend, who is an environmental lawyer and we’ll begin to look for something for him to do in Karatu on our arrival there.

And so it is with neurology and medicine in rural Tanzania. It is not necessarily about the technology we bring (though this can often help), but rather about the relationships we build and the information we pass on to the patients and caregivers that ensures a better life for the populace of this endearing country whose wealth is measured in their determination and hope.

And now it is time for another incredible journey and the experience of a lifetime for those who have chosen to give of themselves to join me here in this paradise in East Africa.